The primary emphasis of the technology assessment (TA) movement to date has been on the development of the statistical tools necessary to carry out technically sound assessments, on the way in which technologies have been disseminated, and on the carrying out of specific assessments. This project, by contrast, primarily will identify, analyze, and respond to the likely moral and quasi-moral (ethical, legal, and clinical) obstacles to the utilization of TA results. The working premise of the project is that understanding the range of possible moral responses to the results of TA is as important as the TA itself. Resolving the moral objections of physicians to using TA results is an important step in the dissemination of TA results. The project will be concerned, in a secondary fashion, with the way in which background moral and social values influence the interpretation of TA results, and with the impact of different moral values on the receptivity to such results. Also, we will evaluate the institutional moral strategies--prototype educational programs, practice guidelines, and in-house strategies developed to overcome resistance to effective utilization of TA results. Since we are providing a moral analysis of the obstacles, our methodology is one commonly employed in clinical ethics. This process includes: identifying the conflict, clarifying the concepts involved with the conflict, comparing the values in conflict with values cherished in medicine, and evaluating action strategies to implement moral responses. Our hypothesis is that the factors which influence the diffusion of technology are similar to the moral and quasi-moral objections physicians give for diminishing TA results. We will test this by means of cases studies that have been chosen by our consultants. We will employ an interdisciplinary groups of consultants and groups at two test sites to help identify the obstacles. In addition the consultants will be used in the analysis and evaluation of the moral problems.